Hysteria: The Elusive Neurosis, 2014

an hysteric makes sexuality out of the therapist's science, while the therapist makes science out of sexuality. In this affair, the hysteric has the advantage, there being more sex to science than vice-versa.

How might hysteria be usefully conceptualized? Charcot (1892), Janet (1892), and Breuer and Freud (1893/1955) posited that hysteria was defined by the presence of physical symptoms, such as paralyses, fits, and pain with little or no organic basis—that is conversion symptoms. Over the years a variety of behavioral traits have been added to the definition, including hyperemotionality, manipulativeness, and seductiveness, among many others.

Rangell (1959) persuasively argued in his classic paper that conversion symptoms occur in a wide variety of personality organizations, from the neurotic to the psychotic; they are not limited to one personality type. Psychogenic physical symptoms which have an underlying meaning can occur in many types of patients. Zetzel, in “The So-Called Good Hysteric,” (1968) argued that defining hysteria by overt, behaviorally-defined personality traits is misleading; she cogently argued for a definition that looks at ego functions, personality strengths and deficits, as well as underlying intrapsychic conflicts, to rule a patient in or out of the diagnosis. But many case presentations of purported hysterics over the years begin with unsupported assertions that amount to, “I have an hysterical patient,” and then talk about etiology and other aspects of that patient's problems, without establishing why the patient was considered “hysterical” in the first place.

The core psychoanalytic conflict theory (Freud, 1926/1959), along with Hartmann's ego psychology (1939/1958), augmented by cross cultural and historical perspectives, supply the raw materials for defining and explaining hysterical personality in a truly psychoanalytic fashion. I sought to integrate these into a comprehensive theory of hysteria in Hysteria: th